Systematic Advance Care Planning and Potentially Avoidable Hospitalizations of Nursing Facility Residents

Hickman, Susan E.; Unroe, Kathleen T.; Ersek, Mary; Stump, Timothy E.; Tu, Wanzhu; Ott, Monica; Sachs, Greg A.

doi:10.1111/jgs.15927

Cited by 25 publications

(19 citation statements)

References 35 publications

(87 reference statements)

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“…There are also studies that inform that patients with dementia and good palliative care attend less to emergency units [34]. Furthermore, other authors say that regular care to nursing homes would improve palliative care for older people and reduce visits to emergency units and longs hospitalizations [35].…”

Section: Discussionmentioning

confidence: 99%

Nurses Training and Capacitation for Palliative Care in Emergency Units: A Systematic Review

et al. 2020

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Background and objectives: Palliative care (PC) prevents and alleviates patients´ suffering to improve their quality of life in their last days. In recent years, there has been an increase in visits to the emergency services (ES) by patients who may need this type of care. The aims were to describe the training and capacitation of nurses from ES in PC. Accordingly, a systematic review was performed. Materials and Methods: Medline, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were used. The search equation was “Palliative care and nursing care and emergency room”. A total of 12 studies were selected. Results: The studies agree on the need for training professionals in PC to provide a higher quality care, better identification of patient needs and to avoid unnecessary invasive processes. Similarly, the implementation of a collaborative model between ES and PC, the existence of a PC specialized team in the ES or proper palliative care at home correspond to a decrease in emergency visits, a lower number of hospitalizations or days admitted, and a decrease in hospital deaths. Conclusions: The development of PC in the different areas of patient care is necessary. Better palliative care leads to a lower frequency of ES by terminal patients, which has a positive impact on their quality of life. Access to PC from the emergency unit should be one of the priority health objectives due to increment in the aged population susceptible to this type of care.

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Section: Discussionmentioning

confidence: 99%

Nurses Training and Capacitation for Palliative Care in Emergency Units: A Systematic Review

et al. 2020

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“…In addition to this intensive ACP training, all project RNs and NPs complete the geriatric version of the End-of-Life Nursing Education Consortium training. [23][24][25] During Phase I, a palliative care physician provided consultation and support for project RNs and NPs for up to 4 hours per week around difficult cases. At the outset of Phase II, the leadership team decided to invest more in the palliative care component of the intervention.…”

Section: Rns and Nps Receive Training In Advance Care Planning Using mentioning

confidence: 99%

The Role of the Palliative Care Registered Nurse in the Nursing Facility Setting

Hickman

Parks

Unroe

et al. 2020

J Hosp Palliat Nurs

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There is a growing recognition of significant, unmet palliative care needs in nursing facilities, yet limitations in the workforce limit access to palliative care services. Attention to palliation is particularly important when there are efforts to reduce hospitalizations to help ensure there are no unintended harms associated with treating residents in place. A specialized palliative care Registered Nurse (PCRN) role was developed as part of the OPTIMISTIC program, a federally funded project to reduce potentially avoidable hospitalizations. Working in collaboration with existing clinical staff and medical providers, the PCRN focuses on managing symptoms, advance care planning, achieving goal concordant care, and promoting quality of life. The PCRN serves as a resource for families through education and support. The PCRN also provides education and mentorship to staff to increase their comfort, knowledge, and skills with end-of life care. The goal of this article is to provide an overview of the PCRN role and its implementation in nursing facilities, and describe core functions that are transferrable to other contexts.

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“…Tenth, while there are increasing articles on MOLST/POLST (Hickman et al 2018(Hickman et al , 2019, more research is needed on both the program and sustainable implementation of the MOLST/POLST paradigm programs (National POLST 2019).…”

Section: Future Directions Of Researchmentioning

confidence: 99%

Advance Care Planning: Medical Orders at the End of Life (MOLST, POLST)

Bomba¹

2020

Encyclopedia of Gerontology and Population Aging

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Medical orders for life-sustaining treatment (MOLST); Medical orders for scope of treatment (MOST); Physician orders for life-sustaining treatment (POLST); Physician orders for scope of treatment (POST); POLST paradigm program (PPP); Portable medical orders for life-sustaining treatment (POLST); Provider orders for life-sustaining treatment (POLST) Definition Advance Care Planning Advance care planning (ACP) is a communication process that aims to help an individual plan for future medical care if the person is unable to make his or her own medical decisions. An estimated 45-70% of older adults facing end-oflife (EOL) treatment decisions are incapable of making those decisions themselves (Institute of Medicine [IOM] 2014). ACP helps an individual prepare for a sudden unexpected illness or injury, from which the person may recover, as well as the dying process and ultimately death. The goal of ACP is to ensure that individuals receive care consistent with their expressed preferences during serious and chronic illnesses (Sudore et al. 2017). An additional goal of ACP is to ensure the desired care will help the person live well as death approaches and die in their preferred setting. ACP applies to all adults 18 years of age and older. ACP empowers a person to authorize a trusted individual to make future health decisions if and only if the person cannot do so and to share personal values, beliefs, and what matters most ahead of time. Advance directives (AD) are legal documents completed at the end of the ACP process that outline a plan for future care in the event a person loses the ability to make medical decisions, like the healthcare proxy (HCP) or durable power of attorney for health care (DPAHC) and the living will (LW). Medical Orders at the End of Life Medical orders at the end of life are patient-centered decisions that outline current patient preferences for cardiopulmonary resuscitation in the event of cardiac and/or pulmonary arrest as well as preferences in the event of cardiac and/or pulmonary insufficiency, including but not limited to ventilator support, hospitalization, artificial hydration and nutrition, antibiotics, dialysis, blood transfusions, etc. Creation of a set of medical orders is based on a thoughtful discussion and/or series of discussions with the seriously ill

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Systematic Advance Care Planning and Potentially Avoidable Hospitalizations of Nursing Facility Residents

Cited by 25 publications

References 35 publications

Nurses Training and Capacitation for Palliative Care in Emergency Units: A Systematic Review

Nurses Training and Capacitation for Palliative Care in Emergency Units: A Systematic Review

The Role of the Palliative Care Registered Nurse in the Nursing Facility Setting

Advance Care Planning: Medical Orders at the End of Life (MOLST, POLST)

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